Black to the future

The Black Report and the overhaul of Incapacity Benefit show health and wellbeing issues entering the mainstream. Now advisers need to take up the baton, says Helen Monks

As headlines decry an apparent epidemic of obesity, binge-drinking and incapacity benefit junkies, corporate advisers have an ever-expanding choice of health and wellbeing benefits to sell to clients worried about their workers’ health.

With the Government now taking occupational health issues considerably more seriously than it has in the past, it should now be easier than ever for advisers to persuade employers of the virtues that the solutions on the market offer. Yet there are still challenges in promoting health and wellbeing products to sceptical finance directors, particularly at a time when many companies are trimming their costs.

Dame Carol Black’s recent report into the health and wellbeing of the UK’s working population details how mental health problems and musculoskeletal conditions are the major causes of sickness, work absence and inability to work due to ill-health.

Government statistics hint at the potential value for employers of setting up preventative or quick-response health and well being programmes.

The cost to the taxpayer of such health issues is estimated at over £60bn, once the lost tax revenue, the cost of benefits and the additional costs to the NHS are taken into account.

While the impact on the public purse is clear, the challenge for advisers is taking that logic into the workplace and demonstrating the clear case that setting up a well being EAP will have a positive impact on a company’s bottom line.

Although a 2006 study by the Harvard Medical School and the Institute for Health and Productivity Management suggested that the healthiest 25 per cent of the workforce is some 18 per cent more productive than the least healthy quarter, the Chartered Institute of Personnel and Development is among those stakeholders who have said there is little concrete research into the link between well being and increased employee productivity.

Heath Lambert Consulting regional director Karen Gamble says: “When we are selling programmes it can be on the back of anecdotal evidence and some elements of well being initiatives can be, by their nature, highly subjective. How can you, for example, measure the impact of putting a bowl of fresh fruit on peoples’ desks every day?”

Even some product providers concede the commercial case for EAPs, both in terms of boosted productivity and better absence management, is far from concrete.

Though advisers cannot attend client consultations armed with cut and dried cost-benefit analysis of EAPs, the good news is that they can still promise a clearly demonstrable payback for establishing such schemes.

Says Gamble: “Stress helplines should appeal to employers because it can knock as much as 10 per cent off their liability insurance as well as acting as a plank of the defence if they face stress-related claims from employees.”

In terms of where wellbeing EAPs are located in the overall benefits packages, evidence from advisers suggest they are rarely sold as a stand-alone benefit and are viewed, both by providers and advisers, as an add-on to the more core benefits of income protection, critical illness or private medical insurance.

David Taylor, director at Morgans Corporate Benefits says: “We have sold just a few stand-alone EAPs. These are the kind of products that a couple of years ago were used by some insurers as something to differentiate their proposition, but now are almost expected as an add-on.”

In this context advisers experienced in this area say that wellbeing EAPs are not a difficult sell.

Simon Curtis, health and risk consultant health at Jardine Lloyd Thompson says: “They are one of those benefits which have been around for some time and flavour of the month for some time. I don’t find that too many employees are looking for answers to the question: “If I put this in place, how much will we save”. They see it more as duty of care. The other reason EAPs are relatively easy to advise on is that they are low-cost.”

Gamble suggests that for an organization of 20,000 or more employees the cost might be around £4-5 per person per year. Between 1,000 and 20,000 staff costs rise to between £8 and £9 a head. But even below this figure the costs are still a relatively low £12 to £18 per person per year.

These costs are not prohibitive, even to the smallest SME. Gamble also makes the point that even businesses that might have to pay towards the top end of the cost scale can reduce costs per head by tailoring the plan to restrict the number of face-to-face counseling hours making-up the package.

Those shopping around for the best EAP packages for clients are also urged to exercise care when assessing the counseling available as part of the service.

For example, Mike O’Donnell, chief medical officer at Unum warns against services that could potentially exacerbate an individual’s stress-related problems: “Watch out for the quality of counseling available. Some counsellors will be focused on delving deep into a person’s background to look for the answers over why they are stressed as opposed to suggesting strategies to cope or instruction on how they might talk to their employer about their stress-related issue.”

Other criteria that advisers suggest factoring in to choosing an EAP provider include the breadth of services against cost and how far the EAP provider can deliver those services itself: “Anyone can say they have their own branded EAP and not have very much behind it. Look at how far the provider has to outsource services to a third party. There is much greater security in having a provider who can offer most of its services in-house,” says Curtis.

EAPs are typically easy to set-up and once the package is bought, there can be little more to do than ensure staff know what is available and what numbers to call when.

However, once in place, there is some doubt over how well used EAP services are by employees.

Taylor says the evidence suggests that use of EAPs is low, but the feel good factor is high, with staff feeling their employer genuinely cares more for their health and wellbeing.

But Gamble is less optimistic. He says: “It tends to go that a programme gets set up, you have something on the intranet, a few leaflets are given out, then it’s forgotten about and everyone moves on to something else.”

Worryingly perhaps, Curtis says he has heard of one EAP for 1,500 staff that was not used once in two years before it was taken away. He says at the heart of this sort of occurrence and low usage generally is the fact that EAPs are a low-cost benefit, which makes it inappropriate to charge fees on advice to boost take-up.

He suggests that keeping the range of benefits on offer relatively low is one way of boosting awareness and usage. He reasons that when what is on offer is too diverse, the information is less likely to seep in to the workforce’s collective consciousness which therefore leads to low usage.

Alternatively, advisers can tailor the workplace marketing of the plan to focus on the key elements they understand are most likely to be popular and valued by employees.

Providers ought to be able to tell advisers what this might be. For example, Standard Life Healthcare says that analysis of the last 1,000 plans it put in place for SMEs showed three-quarters wanted its GP consultation line.

Employers interested in extracting management information from helplines should be made aware of the possibilities and indeed this could make EAPs more attractive to unconvinced finance directors.

However, advisers need to be realistic about the limitations of EAPs in this respect or potentially harm their long-term relationships with clients.

Calls to helplines are confidential per se and management cannot know who made the calls and what specifically was discussed.

Typically speaking, they are permitted to know roughly the type of calls being made, for example, whether people tend to call the helpline if they have been bereaved, if they are stressed at work or worried about their weight or alcohol intake.

But whether even this information is meaningful or not depends on call volumes being sufficiently high.

Julian Ross, head of policy communications at Standard Life Healthcare says: “Where many people are using the service you can pull out trends such as high stress or low exercise as areas managers might need to consider looking at more closely.”

Ross suggests that the case for knowing where the ill-health and absence trigger points might be could particularly resonate for SMEs where the loss of staff means not only do those at work have to work harder, but they could lose important business if a member of their sales team is absent due to stress, for example.

One area where advisers can tell would-be clients how health and wellbeing EAPs can be of help to senior level personnel is in cases where managers are charged with dealing with those who have specific problems, such as stress or bereavement: “Managers need support too. You can look upon assistance programmes as a holistic service for everyone. Who better to speak to if your staff is having a problem than someone who is used to helping people for a living?” suggest O’Donnell.

A June 2007 report by the CIPD which looked at health and wellbeing in the workplace concluded that never before has there been such a clear need to recognise that the health and wellbeing of organisations, employees and wider society are interconnected.

The report argued that organisations are under pressure from three sides to address the wellbeing agenda.

These pressure points include the drive internally to face the costs and risks of long-term sickness and absence that could threaten productivity, growth and brand.

There are also increasingly-demanding employees to cope with who are starting to expect their employers to help them achieve individual wellbeing.

Finally, there is the growing pressure from Government driving employers to recognise their impact on employee health and their role in helping the Government’s aim to get more of the working age population active in the workplace.

While it might not be a priority selling message for corporate advisers today, over the next few years the importance of the workplace as an arena for boosting the UK’s health and well being is likely to creep up the agenda and form an increasingly important part of discussions with clients.

Says Gamble: “The Government’s wellbeing strategy is an in for us. Although it has not yet much permeated the SME market. We can expect these messages to start to filter through to smaller businesses in the near future.”

policy: Dame Carol Black

In March the National Director for Health and Work, Dame Carol Black published the first ever review into the health of the working age population – Working for a Healthier Tomorrow.

It sets out a baseline for health of the working age population and highlights that while people are living longer, this has not been accompanied by people saying they feel healthier.

Amongst other things the report tells us that smoking rates currently stand at 22 per cent and if current trends continue, a staggering 90 per cent of men and 80 per cent of women will be obese by 2050.

Black’s report stems from the Government’s wider Health, Work and Wellbeing strategy. Launched in 2005, this strategy is aimed at improving the health and wellbeing of people of working age and to assist in reducing health inequalities and social exclusion by improving workers’ overall health and wellbeing.

Practically speaking, the Government wants to see less people becoming ill or injured

through work. It

is also concerned that people are kept healthy in work and are provided with accessible support to enable them to remain in or return to work more quickly.

It also promotes the use of the workplace as an opportunity for general health improvement where early responses are made when health problems arise.

It is hoped the efforts of employers will help reduce the economic and social impact of the 175 million days of sick leave taken in 2006, also detailed in Black’s report.

EAPs

Employee assistance programmes (EAPs) that incorporate wellbeing benefits include a diverse range of services, such as helplines providing employees with 24-hour access to counseling, over-the-phone advice from a GP, through to nutritional advice and online health and stress monitoring.

The majority of providers have moved quickly to add EAP services to their offerings and there is a wide variety to choose on, whether on a standalone basis or incorporated in other products.

Standard Life Healthcare, for example, offers four preventative modules as part of its business packages. The employee assistance programme module offers 24 hour access to counsellors, access to legal advice, as well as health and well-being guidance.

Similarly, Norwich Union’s personal health manager package includes a confidential symptom assessment service linked to the employee’s GP, health and lifestyle assessment tools and tailored action plans to help reduce staff health risks and maintain wellbeing.

Last December Employee Advisory Resource launched an EAP that it says differentiates itself from other providers by offering an advanced clinical outcomes measurement system. The Evolution EAP has been designed to directly link service outcomes with the overall efficiency and value for money of the EAP service.

Meanwhile Legal & General offers a basic but free employee assistance programme on all its group risk products.

Last year Bupa added its Positive Health product to all group schemes. This is an online health and wellbeing assessment that can provide personalised recommendations to help employees improve their health.